Cleaning Estimate / Client Survey Form
First Name
Last Name
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Phone Number
Email Address
Residential Information
Please answer the following questions regarding your residence. How many of each of room(s) are contained in your residence?
1
1.5
2
2.5
3
3.5
4
Kitchen
Living Room/Great Room
Bedroom(s)
Family Room/Den
Bathroom(s)
Other Room (s)
Does your home contains stairs?
Yes
No
What type of floor(s) are contained in your home?
Carpet
Tile
Vinyl
Marble
Other
Frequency of cleaning
Weekly
Bi-Weekly
Monthly
One-Time
Other
Client Survey
We have developed this questionnaire to help us gain a clearer understanding of what your needs and expectations are from our service. Please rate the following in terms of their importance to you.
Very Important
Somewhat Important
Not Important
Not Sure
1. Attention to detail
2. Overall level of customer service
3. Friendliness of staff
4. Open lines of communication
5. A consistent quality of service
6. Complaint resolution
7. Satisfaction
8. Loyalty
9. Trustworthiness
Type of cleaning products desired? Select as many as desired.
Store Brands
Green Products
Professional Strength
No Preference
Comments or Suggestions
Indicates Response Required
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